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IgM antibody to hepatitis B core antigen is a reliable marker for acute disease for a hepatitis B viral infection. At times this marker is the only one demonstrated for the diagnosis of a hepatitis B viral infection.
Anti-HBc appears 5 to 14 days after HBe antigen and can be found shortly before HBsAg is no longer detectable. It may be negative in 9% of patients with acute hepatitis B in the first two weeks of illness, and should be repeated if clinically warranted. Anti-HBc and anti-HBe may be the only markers detectable in some patients at the time of presentation. The period between the disappearance of HBsAg and the appearance of HBsAb is often called the “core window.” Anti-HBc persists for months to years after resolution of acute hepatitis B, and also persists in cases of chronic infection; however, the demonstration of IgM-specific HBcAb is evidence that the patient is in an acute infection. Conversely, the absence of IgM core antibody in a patient with long-term B surface antigenemia suggests chronic hepatitis B viral infection. In addition, the absence of IgM core antibody with persistent B surface antigen and symptoms of acute hepatitis suggests acute non-A, non-B hepatitis or superinfection with δ hepatitis. See figure.
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